Hi, has anyone actually billed BCBS MSHO episodically for home care services?
From: list-manager@list.mnhomecare.org [mailto:list-manager@list.mnhomecare.org]
On Behalf Of Beth Taylor
Sent: Friday, February 13, 2015 12:30 PM
To: billers@list.mnhomecare.org
Subject: RE: Medicare
You need to bill the managed care plan if the Client is on an MSHO plan, at least for home care. UCare allows you to bill using the Medicare codes, and BCBS MSHO will actually
allow you to bill episodically. But Medica from what I understand doesn’t accept Medicare coding at all, we bill using the MA codes for Medica MSHO. They have a different setup there.
These are the most common MSHO plans that I see, hopefully this helps!
Beth Taylor l Prior Auth Manager
2586 7th Ave E, Suite 302
| North St. Paul, MN 55109
Main: (651) 633-7300
| Fax: (651) 633-7301
www.firstnationshomehealth.com
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From:
list-manager@list.mnhomecare.org [mailto:list-manager@list.mnhomecare.org]
On Behalf Of Purrier,April
Sent: Friday, February 13, 2015 11:36 AM
To: 'billers@list.mnhomecare.org'
Subject: RE: Medicare
Thank you for your help. I’m happy to know I’m not the only one questioning this. Do you know if you can bill Medicare directly if the client has Medica MSHO? My understanding is that you would need to bill the county plan.
From:
list-manager@list.mnhomecare.org [mailto:list-manager@list.mnhomecare.org]
On Behalf Of Beth Taylor
Sent: Friday, February 13, 2015 11:31 AM
To: billers@list.mnhomecare.org
Subject: COMMERCIAL:RE: Medicare
I bill for home care services, so if you are doing the same, I do not believe you can bill for supplies unless you are a DME. Best case you should have the DME or supplier bill
Medica on the Client’s behalf, so that you don’t have to cover the cost, since it’s not episodic coverage under that type of plan. And we do bill Medica MSHO per visit, from what I’ve been told they don’t accept or process episodically.
Each MCO seems to manage their MSHO coverage differently, but generally I don’t think the MSHO plans will cover supplies unless you are able to bill episodically.
I hope this is accurate, if anyone else has experience with this I’d also be very curious about other experiences as this has come up with us a few times.
Beth Taylor l Prior Auth Manager
2586 7th Ave E, Suite 302
| North St. Paul, MN 55109
Main: (651) 633-7300
| Fax: (651) 633-7301
www.firstnationshomehealth.com
Information contained in this e-mail transmission is the property of the sender's employer and is intended for the named recipient. If you are not the intended recipient, do not read, distribute,
or reproduce this transmission. If you have received this e-mail transmission in error, please contact the sender.
Disclaimer Regarding Uniform Electronic Transmissions Act (UETA) and Federal E-Sign (E-SIGN) Law: This communication is for discussion purposes only, and it does not create a contract or legally
binding agreement. The UETA and E-SIGN do not apply to this communication.
From:
list-manager@list.mnhomecare.org [mailto:list-manager@list.mnhomecare.org]
On Behalf Of Purrier,April
Sent: Friday, February 13, 2015 11:25 AM
To: 'billers@list.mnhomecare.org'
Subject: Medicare
Hi there,
I am wondering if a client has Medicare as well as a county payer, Medica MSHO to be exact, do we have to bill Medica MSHO? From what I have been told, you have to bill county. The reason why I am wondering is because we bill supplies to
Medicare PPS, but when billing Medica MSHO, it bills per visit and therefore we are not able to bill supplies. It would be nice to be reimbursed for the supplies we are providing, but obviously I do not want to be billing Medicare directly if that is not the
correct procedure. Any help would be greatly appreciated. Thank you for your time!
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